Bali & Lombok 2019 Registration Questions
Full Name (Please write it *exactly* as written in your Passport, including middle name) *
Your answer
Preferred name (or nickname)
Your answer
Date of Birth *
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Home Address (please include street address; city; state; ZIP; country) *
Your answer
Best phone number to reach you *
Just in case we need to get ahold of you more quickly than via email!
Your answer
Email address *
Your answer
Passport country of issue *
Your answer
Passport number *
Your answer
Expiration date of passport *
IMPORTANT: Your passport must have at least six months validity from the end of the trip and at least two blank pages in it.
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Will you have a single room or a shared room on this trip? *
If you are willing to share but don't have a roommate already, we can let you know if others are in a similar situation. However, we can't guarantee that you will have a roommate.
If you are sharing a room, what is your roommate's name?
Your answer
Occupation & Interests: Please tell us more about you so we can make sure you get the most out of your time with us! We can help find little gems along the way that are in line with your interests. *
Your answer
Emergency contact information *
Name; Relationship; Phone Number; Email (of someone not traveling with you)
Your answer
Food allergies (gluten, dairy, etc) / Dietary restrictions (vegetarian, vegan, etc)
Your answer
Do you have any health conditions and/or severe allergies (food, drug, or environmental) we should be aware of? Do you use any medications you will need refrigerated or medical devices that require electricity?
Your answer
What are you hoping to experience on this journey? How can we help you get the most out of your time on this trip? *
Your answer
How did you first learn about this trip? *
Your answer
Please read and sign the Tour Contract and Liability Waiver below (You can access and download a copy for your records at this link: http://bit.ly/2018RetreaToursContract)
I agree to the Tour Contract and Liability Waiver *
Required
Please sign below with your digital signature which consists of your full name *
Example: John Q. Sample
Your answer
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